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Is Marginal Bone Loss around Oral Implants the Result of a Provoked Foreign Body Reaction?

Identifieur interne : 001A76 ( Istex/Corpus ); précédent : 001A75; suivant : 001A77

Is Marginal Bone Loss around Oral Implants the Result of a Provoked Foreign Body Reaction?

Auteurs : Tomas Albrektsson ; Christer Dahlin ; Torsten Jemt ; Lars Sennerby ; Alberto Turri ; Ann Wennerberg

Source :

RBID : ISTEX:36AF7A4A8DD2C74DF22206D697C89162A4942625

Abstract

When a foreign body is placed in bone or soft tissue, an inflammatory reaction inevitably develops. Hence, osseointegration is but a foreign body response to the implant, which according to classic pathology is a chronic inflammatory response and characterized by bone embedding/separation of the implant from the body.

Url:
DOI: 10.1111/cid.12142

Links to Exploration step

ISTEX:36AF7A4A8DD2C74DF22206D697C89162A4942625

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Background
<p>When a foreign body is placed in bone or soft tissue, an inflammatory reaction inevitably develops. Hence, osseointegration is but a foreign body response to the implant, which according to classic pathology is a chronic inflammatory response and characterized by bone embedding/separation of the implant from the body.</p>
Purpose
<p>The aim of this paper is to suggest an alternative way of looking at the reason for marginal bone loss as a complication to treatment rather than a disease process.</p>
Materials and Methods
<p>The present paper is authored as a narrative review contribution.</p>
Results
<p>The implant‐enveloping bone has sparse blood circulation and is lacking proper innervation in clear contrast to natural teeth that are anchored in bone by a periodontal ligament rich in blood vessels and nerves. Fortunately, a balanced, steady state situation of the inevitable foreign body response will be established for the great majority of implants, seen as maintained osseointegration with no or only very little marginal bone loss. Marginal bone resorption around the implant is the result of different tissue reactions coupled to the foreign body response and is not primarily related to biofilm‐mediated infectious processes as in the pathogenesis of periodontitis around teeth. This means that initial marginal bone resorption around implants represents a reaction to treatment and is not at all a disease process. There is clear evidence that the initial foreign body response to the implant can be sustained and aggravated by various factors related to implant hardware, patient characteristics, surgical and/or prosthodontic mishaps, which may lead to significant marginal bone loss and possibly to implant failure. Admittedly, once severe marginal bone loss has developed, a secondary biofilm‐mediated infection may follow as a complication to the already established bone loss.</p>
Conclusions
<p>The present authors regard researchers seeing marginal bone loss as a periodontitis‐like disease to be on the wrong track; the onset of marginal bone loss around oral implants depends in reality on a dis‐balanced foreign body response.</p>
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<copyright ownership="publisher">© 2013 Wiley Periodicals, Inc.</copyright>
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<correspondenceTo>Reprint requests: Professor Tomas Albrektsson, Department of Biomaterials, Sahlgrenska Academy, PO Box 412, Göteborg SE 405 30, Sweden; e‐mail:
<email>tomas.albrektsson@gu.se</email>
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<title type="short">Osseointegration as a Foreign Body Reaction</title>
<title type="main">Is Marginal Bone Loss around Oral Implants the Result of a Provoked Foreign Body Reaction?</title>
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<degrees>MD, PhD, RCPSG</degrees>
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<personName>
<givenNames>Christer</givenNames>
<familyName>Dahlin</familyName>
<degrees>DDS, PhD</degrees>
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<creator affiliationRef="#cid12142-aff-0004 #cid12142-aff-0005" creatorRole="author" xml:id="cid12142-cr-0003">
<personName>
<givenNames>Torsten</givenNames>
<familyName>Jemt</familyName>
<degrees>DDS, PhD</degrees>
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<personName>
<givenNames>Lars</givenNames>
<familyName>Sennerby</familyName>
<degrees>DDS, PhD</degrees>
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</creator>
<creator affiliationRef="#cid12142-aff-0001 #cid12142-aff-0005" creatorRole="author" xml:id="cid12142-cr-0005">
<personName>
<givenNames>Alberto</givenNames>
<familyName>Turri</familyName>
<degrees>DDS, PhD cand</degrees>
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<personName>
<givenNames>Ann</givenNames>
<familyName>Wennerberg</familyName>
<degrees>DDS, PhD</degrees>
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<orgDiv>Department of Biomaterials</orgDiv>
<orgName>Göteborg University</orgName>
<address>
<city>Göteborg</city>
<country>Sweden</country>
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<affiliation countryCode="SE" xml:id="cid12142-aff-0002">
<orgDiv>Department of Prosthodontics</orgDiv>
<orgName>Malmö University</orgName>
<address>
<city>Malmö</city>
<country>Sweden</country>
</address>
</affiliation>
<affiliation countryCode="SE" xml:id="cid12142-aff-0003">
<orgDiv>Department of Oral& Maxillofacial Surgery</orgDiv>
<orgName>NU Hospital Group</orgName>
<address>
<city>Trollhättan</city>
<country>Sweden</country>
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<affiliation countryCode="SE" xml:id="cid12142-aff-0004">
<orgDiv>Department of Prosthetic Dentistry/Dental Material Science</orgDiv>
<orgName>University of Göteborg</orgName>
<address>
<city>Göteborg</city>
<country>Sweden</country>
</address>
</affiliation>
<affiliation countryCode="SE" xml:id="cid12142-aff-0005">
<orgDiv>The Brånemark Clinic</orgDiv>
<orgName>Public Dental Health Service</orgName>
<address>
<city>Göteborg</city>
<country>Sweden</country>
</address>
</affiliation>
<affiliation countryCode="SE" xml:id="cid12142-aff-0006">
<orgDiv>Department of Oral and Maxillofacial Surgery</orgDiv>
<orgName>Göteborg University</orgName>
<address>
<city>Göteborg</city>
<country>Sweden</country>
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<keyword xml:id="cid12142-kwd-0001">bone loss</keyword>
<keyword xml:id="cid12142-kwd-0002">dental implants</keyword>
<keyword xml:id="cid12142-kwd-0003">foreign body reaction</keyword>
<keyword xml:id="cid12142-kwd-0004">osseointegration</keyword>
<keyword xml:id="cid12142-kwd-0005">peri‐implantitis</keyword>
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<fundingInfo>
<fundingAgency>Sylván Foundation</fundingAgency>
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<title type="main">Abstract</title>
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<title type="main">Background</title>
<p>When a foreign body is placed in bone or soft tissue, an inflammatory reaction inevitably develops. Hence, osseointegration is but a foreign body response to the implant, which according to classic pathology is a chronic inflammatory response and characterized by bone embedding/separation of the implant from the body.</p>
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<title type="main">Purpose</title>
<p>The aim of this paper is to suggest an alternative way of looking at the reason for marginal bone loss as a complication to treatment rather than a disease process.</p>
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<p>The present paper is authored as a narrative review contribution.</p>
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<title type="main">Results</title>
<p>The implant‐enveloping bone has sparse blood circulation and is lacking proper innervation in clear contrast to natural teeth that are anchored in bone by a periodontal ligament rich in blood vessels and nerves. Fortunately, a balanced, steady state situation of the inevitable foreign body response will be established for the great majority of implants, seen as maintained osseointegration with no or only very little marginal bone loss. Marginal bone resorption around the implant is the result of different tissue reactions coupled to the foreign body response and is not primarily related to biofilm‐mediated infectious processes as in the pathogenesis of periodontitis around teeth. This means that initial marginal bone resorption around implants represents a reaction to treatment and is not at all a disease process. There is clear evidence that the initial foreign body response to the implant can be sustained and aggravated by various factors related to implant hardware, patient characteristics, surgical and/or prosthodontic mishaps, which may lead to significant marginal bone loss and possibly to implant failure. Admittedly, once severe marginal bone loss has developed, a secondary biofilm‐mediated infection may follow as a complication to the already established bone loss.</p>
</section>
<section xml:id="cid12142-sec-0005">
<title type="main">Conclusions</title>
<p>The present authors regard researchers seeing marginal bone loss as a periodontitis‐like disease to be on the wrong track; the onset of marginal bone loss around oral implants depends in reality on a dis‐balanced foreign body response.</p>
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<abstract>When a foreign body is placed in bone or soft tissue, an inflammatory reaction inevitably develops. Hence, osseointegration is but a foreign body response to the implant, which according to classic pathology is a chronic inflammatory response and characterized by bone embedding/separation of the implant from the body.</abstract>
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<abstract>The implant‐enveloping bone has sparse blood circulation and is lacking proper innervation in clear contrast to natural teeth that are anchored in bone by a periodontal ligament rich in blood vessels and nerves. Fortunately, a balanced, steady state situation of the inevitable foreign body response will be established for the great majority of implants, seen as maintained osseointegration with no or only very little marginal bone loss. Marginal bone resorption around the implant is the result of different tissue reactions coupled to the foreign body response and is not primarily related to biofilm‐mediated infectious processes as in the pathogenesis of periodontitis around teeth. This means that initial marginal bone resorption around implants represents a reaction to treatment and is not at all a disease process. There is clear evidence that the initial foreign body response to the implant can be sustained and aggravated by various factors related to implant hardware, patient characteristics, surgical and/or prosthodontic mishaps, which may lead to significant marginal bone loss and possibly to implant failure. Admittedly, once severe marginal bone loss has developed, a secondary biofilm‐mediated infection may follow as a complication to the already established bone loss.</abstract>
<abstract>The present authors regard researchers seeing marginal bone loss as a periodontitis‐like disease to be on the wrong track; the onset of marginal bone loss around oral implants depends in reality on a dis‐balanced foreign body response.</abstract>
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